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Table of Contents
Factual Questions...............................................
Premium Questions...............................................
Interpretive Questions..........................................
Notes.........................................................

----Factual Questions----

1) The omentum was recognized as a useful adjunct for repair of _______ _______ and
duodenal.
Answer: friable gastric

2) Almost 175 years later, Crisp reported 50 cases of perforated ulcer disease. In
many ways, he opened the door to modern surgical management of this disease.
Answer: True

3) Another major breakthrough in the. management of peptic _______ _______ occurred

in 1982 with the recognition that an.
Answer: ulcer disease

4) Of patients with peptic _______ _______ are managed medically with NSAID
discontinuation.
Answer: ulcer disease

5) Utilization of _______ _______ in conjunction with bismuth salts eliminated H.

pylori.
Answer: antibiotic regimens

6) We’ve discovered. that the omentum, which we so artfully secure to _______

_______, frequently.
Answer: perforated ulcers

7) Than it needs to be.” “Keep it simple” were the words of my mentors during
_______ _______.
Answer: surgical residency

8) In 1885. In many ways, _______ opened the door to modern surgical management of
this disease.
Answer: he

9) Of the pathophysiology and treatment of _______ _______ transpired.

Answer: ulcer disease

10) Another major breakthrough in the. management of peptic ulcer disease occurred
in _______ with the recognition that an.
Answer: 1982
A)1982
B)1983
C)1972
D)1981

11) Vagotomy were included during _______ _______ for initial perforations, out of.

Answer: index procedures

12) PatientsCanadianwith contained perforations without diffuse peritonitis or

septic shock, nonoperative management with nasogastric decompression, intravenous
fluids, antibiotics, proton pump inhibitors, NSAID discontinuation, and H. pylori
eradication.
Answer: False
Correct Sentence: patients with contained perforations without diffuse peritonitis
or septic shock, nonoperative management with nasogastric decompression,
intravenous fluids, antibiotics, proton pump inhibitors, NSAID discontinuation,
and H. pylori eradication.

13) The face of _______ _______ over the few decades.

Answer: gastrointestinal surgery

14) the safety and efficacy of postoperative medical management with H. pylori
eradication, less aggressive surgery appears to be the most prudent course of
action in most.
Answer: True

15) Between nonsteroidal anti-inflammatory drug use and peptic _______ _______.
Answer: ulcer disease

16) The effectiveness of _______ _______ of peptic ulcer disease has changed.
Answer: medical management

17) Perforated peptic ulcers was first reported by the Polish surgeon _______
Mikulicz-Radecki.
Answer: Jan

18) Of the pathophysiology of peptic _______ _______ has improved over the quarter.

Answer: ulcer disease

19) Is advised in all patients with evidence of _______ _______.

Answer: peptic disease

20) Indication for _______ _______, is no longer so straightforward.

Answer: immediate laparotomy

21) It had long. been recognized that a significant fraction of peptic _______
_______ was related to an.
Answer: ulcer disease

22) In cases of _______ _______ or uncontained perforation, early surgery remains

the most effective treatment.
Answer: diffuse peritonitis

23) _______ _______ training, ulcer operations are now relatively rare.
Answer: surgical residency

24) Almost 175 years later, _______ reported 50 cases of perforated ulcer disease.

Answer: Crisp

25) _______, youngest daughter of King Charles I, died of a perforated ulcer in

1670, after.
Answer: England
A)England
B)Netherlands
C)Scotland
D)Spain
26) _______ _______ in Physiology or Medicine for their work, which has improved
the lives of.
Answer: Nobel Prize

27) Of surgeons around the world when dealing with perforated peptic _______
_______.
Answer: ulcer disease

28) Jones, eight years earlier in _______, who described the use of a pedicle of
omentum.
Answer: 1929
A)1929
B)1932
C)1921
D)1928

29) Ends up plugging the hole spontaneously with no _______ _______ at all.
Answer: surgical intervention

30) Almost 82 years later, Crisp reported 50 cases of perforated ulcer disease.
Answer: False
Correct Sentence: Almost 175 years later, Crisp reported 50 cases of perforated
ulcer disease.

31) _______ _______ in the manner of Cellan-Jones is advised.

Answer: flap repair

32) In _______, proton pump inhibitors received approval in.

Answer: 1989
A)1989
B)1994
C)1988
D)1993

----Premium Questions----

33) What was the majority of duodenal ulcers?

Answer: Infection.

34) Who played a major role in the causation of peptic ulcers?

Answer: Helicobacter pylori.

35) Who described the use of a pedicle of omentum?

Answer: Jones.

----Interpretive Questions----

36) What did Princess Henrietta of England say?

Answer:

37) What is the main point of this article?

Answer: Just treat the problem in front of you

38) What has the management of the disease improved?

Answer: more streamlined and more effective
39) How long has the pathophysiology of peptic ulcer disease been improving?
Answer: over the last quarter century

---------Notes----------

As our understanding of the pathophysiology of peptic ulcer disease has

improved, our management has become more streamlined and more effective. Princess
Henrietta of England, youngest daughter of King Charles I, died of a perforated
ulcer in 1670, after several years of abdominal pain and gastrointestinal
complaints. Simple surgical closure of perforations was first reported by the
Polish surgeon Jan Mikulicz-Radecki in 1885. The omentum was recognized as a useful
adjunct for repair of friable gastric and duodenal ulcers and its use was advocated
in the first part of the twentieth century. The effectiveness of medical management
of peptic ulcer disease has changed the face of gastrointestinal surgery over the
last few decades. Once a mainstay of surgical residency training, ulcer operations
are now relatively rare. Nonoperative management with nasogastric decompression,
intravenous fluids, antibiotics, proton pump inhibitors, NSAID discontinuation, and
H. pylori eradication is safe and effective. In cases of diffuse peritonitis or
uncontained perforation, early surgery remains the most effective treatment, and
pedicled omental flap repair in the manner of Cellan-Jones is advised. In the past,
more definitive anti-ulcer procedures including vagotomy and antrectomy and highly
selective vagotomy were included during index procedures for initial perforations.
Unfortunately, these procedures add time and physiologic insult to patients with
marginal hemodynamic parameters. Less aggressive surgery appears to be the most
prudent course of action in most instances of perforated peptic ulcer.

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